To investigate the high frequency ultrasonic wave features of mucocele of the appendix,and to improve the diagnostic ability of the disease . Method： All 5 patients with mucocele of the appendix were confirmed by pathology and surgery . High frequency ultrasonic wave finding were analyzed retrospectively . Result： The high frequency ultrasonic wave demonstrated a mass of low attenuation in the right lower quadrant in all 5 cases . The masses were either spherical (n=2)or elongated (n=3) in shape . Two masses had mural calcification , and 3 had mural enhancement after contrast enhancement . The mucocele inside full liquid was a homogeneous cystic mass in 3 cases,cystic mass with internal septations in 1cases , and cystic mass with peripheral solid tissue in 1 case . Conclusion： The high frequency ultrasonic wave scan is a useful method in diagnosing mucocele of the appendix . The typical high frequency ultrasonic wave findings of appendiceal mucocele is a well-encapsulated,spherical and ellipse or elongated cystic mass in right lower quadrant,sometimes with mural calcification .
Appendiceal mucocele is accumulating distal adhesion due to a cavity of proximal obstruction of Appendix, cystic dilation results less clinical, accounting for only 0.2%~0.3%[1 of surgical resection specimens of Appendix]. Make correct preoperative diagnosis of Mucinous cyst rupture in helps prevent causing peritoneal pseudomyxoma. With the wide application of ultrasonic examination, in particular the advent of high frequency ultrasound on the Appendix lesion visualizes, provide an objective basis for clinical, preoperative diagnosis of appendiceal mucocele is very valuable. This article after collecting high frequency ultrasound in the diagnosis by surgical pathology confirmed 5 cases of mucus, explore its characteristics of high frequency ultrasound to improve the preoperative diagnostic accuracy.
1 data and methods
1.1 information: between September 1998 and collected a total of 5 cases with appendiceal mucoceles. Retrospective analysis of its supersonic performance, 3 cases in which men, women in 2 cases, age 33~69sui, median age of 46 years, were confirmed through pathology. 4 cases of pathologic diagnosis of Mucinous cyst, 1 case of Mucinous cystadenoma. 1 in 5 cases with ovarian chocolate cyst, 1 cases complicated with uterine myoma. Present as right lower abdominal pain, malaise, 2; 2 cases of right lower abdominal masses; no related symptoms of Appendix 1 for uterine myoma came across right lower abdominal cystic disease by ultrasound. 4 cases touched on the right lower abdominal tumor of clinical examination, 3 no tenderness; 1 tenderness but did not touch on the masses. 3 have both row CT examination in 5 cases.
1.2 method: GE company-VIVID7, LOGIQ400CL and LOGIQ500 color multifunction ultrasonic diagnostic equipment, probe frequency is 7.5MHZ~9.0MHZ. Checking patient supine, plus individual patients with left or right lateral position, focus on the right lower abdomen for multiple slices and pressure scanning, the case of right lower abdominal mass abdominal scanning, transvaginal ultrasonography of female married person the necessary rows. Detailed observation of sonographic appearance of the lesions, and shooting or storage.
2 results
High frequency ultrasonography for right lower abdominal cystic masses. Location: are at right Xia abdominal, which blind intestinal inside 3 cases, blind intestinal rear 1 cases, uterine right 1 cases; form: round, and oval or SAC bag shaped, which round 2 cases, oval 2 cases, SAC bag shaped 1 cases; size: long diameter range 4cm~7cm, cross diameter about 2.5cm~4.6cm; edge: boundary clearly, SAC wall not smooth, lost normal three layer form, all layer boundaries not Qing, and echo enhanced 3 cases; part boundary not Qing 1 cases; another 1 cases boundaries not Qing and around organization adhesion. SAC wall has calcification who 2 cases, is arc and the spots shaped strong echo, rear with sound shadow; internal echo: cavity within product full liquid sexual dark area, to no echo mainly, part within has small weak light point echo 3 cases; SAC within has separated 1 cases; another 1 cases for SAC real sexual, to SAC sexual mainly, wall around has real sexual nipple shaped echo bursting to SAC cavity within.
3 routine CT examination, 2 cases of right lower abdomen rounded masses and 1 round right were cases of pelvic egg masses, 3 cases are homogeneous cystic CT density values range 10Hu~17Hu, clear, sharp edges, visible wall calcification. 2 cases of preoperative diagnosis of Appendix mucocele, 1 case of diagnosis of ovarian cystic masses.
3 discussion
Anatomical features of the Appendix 3.1: the appendix is located in the right iliac fossa, is a slender blind pipe, its proximal opening to the cecum inside, about 5cm~7cm long, diameter 0.5cm[2]. Appendiceal lumen is small, easy retention from the intestine of faeces and bacteria, and because the Appendix wall full of nerves, the roots of sphincter-like structure when stimulate contraction or blocked.
3.2 Clinical pathological characteristics of appendiceal mucocele: appendiceal mucoceles less seen, much caused by the inflammatory appendices proximal obstruction, appendectomy highly expansive, secretion of large amounts of mucous epithelial cells form mucus cysts. In pathology are divided into the following 3 subtypes [3]: ① mucosa hyperplasia. Does not have atypical manifestations, histological characteristics similar to the hyperplastic polyps of the colon; ② Mucinous cystadenoma. Displaying localized or diffuse to the mucosa epithelial tumor changes; ③ Mucinous cystadenocarcinoma. Display characteristics of malignant tumor.
Common clinical right lower abdominal pain, discomfort or symptoms include intermittent abdominal pain-right and lower right abdomen Bao Kuai. This set of 5 cases of 2 cases of right lower abdominal pain in chronic appendicitis symptoms of discomfort, no related symptoms of Appendix 1 for uterine myoma accidentally discovered by ultrasound. Literature reports of Appendix mucocele of male and female sex 1:4, average age 55 years, the often non-specific clinical manifestations, about 23%~50%[4] accidental discovery because of abdominal surgery. Rupture of mucous cyst once, however, SAC mucus and mucosal IL into the abdominal cavity, planted in peritoneal epithelial cells (benign or malignant) are continuously secreted mucus, causing abdominal organ extensive adhesions to form a peritoneal pseudomyxoma [5]. Prognosis of appendiceal mucocele in general good, local excision cure; such as appendiceal mucoceles peritoneal pseudomyxoma is formed after the rupture, the prognosis is not good. Therefore, make correct preoperative diagnosis, complete resection of neoplasm in preventing tumor of rupture causing peritoneal pseudomyxoma is important. Current applications of modern imaging technology, especially high-frequency ultrasound and CT in preoperative diagnosis of appendiceal mucocele is very valuable.
3.3 of Appendix mucocele sonographic: typical sonographic appearance of right lower abdomen area boundary clear of Appendix of the circle, ellipse, or capsular-like, thin wall, the loss of the normal three-layer forms, cannot distinguish the layers, and echo-enhanced, not smooth, with or without calcification. Wall calcification as arcs or blob-like, accompanied by acoustic shadow, behind. Cavity inner product full of the liquid dark areas, see fine small point within or associated with linear separation. This group 4 cases are at right Xia abdominal typical parts, and cecum relationship close, are to SAC sexual mainly, which 1 cases for SAC real sexual, operation Hou pathological confirmed for mucus sexual SAC glands tumor; this group another 1 cases by abdominal wall ultrasonic display for ellipse open SAC sexual swollen property, at uterine right, SAC wall not smooth, SAC within visible small intensive light point, uterine left also found a mixed sexual swollen property, consider double side ovarian chocolate cyst, Hou instead by Yin high frequency ultrasonic check, Yu uterine left probes to a mixed sexual swollen property; right ovarian normal, its Qian above analysis and the a long ellipse open SAC sexual swollen property, therein full close light point. Of b in the diagnosis: ① left ovarian chocolate cyst; ② right lower abdominal cystic masses – Appendix Mucinous cyst. Consistent and postoperative pathological diagnosis. The case where tens of Appendix within the pelvic cavity, and right before ovarian cystic mass coverage over the difficult exploration by abdominal wall of high frequency ultrasound and echo of the ovary. Therefore, this situation very difficult abdominal ultrasonography alone on his sources given the correct judgment that should be combined with vaginal ultrasound and CT and clinical symptoms to consider.
CT characteristics of appendiceal mucocele of right lower abdomen Appendix district boundaries clear, sharp, round or oval masses of low density, wall calcification of arcs, curves, or dot, blind intestine was outside pressure to change.
3.4 differential diagnosis: appendiceal mucoceles identification required with right lower abdominal cystic masses, mainly of hydrosalpinx, lymphatic cysts and mesenteric cysts and ovarian cysts and enterogenous cyst, hematoma, [3]. Hydrosalpinx often traceable to the uterus, ovarian cysts, for married female counterparts of the Yin-ultrasonography to diagnosis. Mesenteric cyst wall echo-is not strong, few calcification. Of intestinal duplication cysts in adults is rare.
To sum up, high frequency ultrasound can look directly at the Appendix of forms, compared with CT, high frequency ultrasound with a simple, non-invasive, intuitive, real-time display of lesions, and a number of advantages such as low-cost, repeatable inspection, at the same time clearly shows masses of different circumstances such as ECHO and calcification of the cyst wall. High frequency ultrasound is the most ideal of appendiceal mucocele check method.